Individual provider Active NPI

Sandin Kekic, OTD, OTR/L

  • Occupational Therapist
  • Grand Rapids, MI
National Provider Identifier
1376254458
Registry record updated Mar 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
5201013191 Issued in MI
Practice address
2251 E Paris Ave SE
Grand Rapids, MI 49546-2431
Phone
(616) 447-7799
NPI assigned
Dec 8, 2022
Last updated
Mar 10, 2023By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 10, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapist 225X00000X 5201013191 MI Primary

Addresses

Primary practice location

2251 E Paris Ave SE
Grand Rapids, MI 49546-2431

Mailing address

201 Fulton St W
Grand Rapids, MI 49503-6201

Other practice location 1

570 E Division St
Rockford, MI 49341-1323
Phone (616) 447-7799

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230209000859 MI Practitioner - Occupational Therapist in Private Practice 4880066356 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Occupational Therapist in Private Practice
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Family Health Center, Inc.Group PAC ID 1759370216, 51 clinicians

Practice addresses (Care Compare)

117 W Paterson St
Kalamazoo, MI 49007-2557
Phone (269) 349-2641

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Quality
93.09
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
5201013191MIMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Family Health Center Inc CurrentSince Mar 1, 2023 Accepting new patients
Family Health Center Inc CurrentSince Mar 1, 2023 Accepting new patients
Theraplay, Inc. CurrentSince Dec 9, 2022 Accepting new patients

Locations

2251 East Paris Ave SE
Grand Rapids, MI 49546
Phone (616) 447-7799

117 W Paterson St
Kalamazoo, MI 49007

505 E Alcott St
Kalamazoo, MI 49001
Phone 2693492641 ext. 715

570 E Division St
Rockford, MI 49341
Phone (616) 447-7799

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1670457600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678406400000",
    "number": "1376254458",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 FULTON ST W",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495036201"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2251 E PARIS AVE SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495462431",
            "telephone_number": "616-447-7799"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "570 E Division St",
            "address_purpose": "LOCATION",
            "city": "Rockford",
            "state": "MI",
            "postal_code": "493411323",
            "country_code": "US",
            "telephone_number": "616-447-7799",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KEKIC",
        "first_name": "SANDIN",
        "credential": "OTD, OTR/L",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-12-08",
        "last_updated": "2023-03-10",
        "certification_date": "2023-03-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "MI",
            "license": "5201013191",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.